RN Pharmacology Online Practice 2023 B

18. Vomiting Blood in the urine Positive Chvostek's sign Ringing in the ears

Correct: Rationale:

27. dosage

Correct: Rationale:

Serotonin syndrome symptoms

agitation confusion hallucinations (seeing or hearing things that aren't real) fast heart rate shaking sweating dilated pupils diarrhea rigid muscles

***A nurse is teaching a client who is starting to take amitriptyline. Which of the following findings should the nurse include in the teaching as an adverse effect of the medication? -Muscle twitching -Cough -Urinary retention -Increased libido

Correct: Urinary retention Rationale: The nurse should instruct the client that amitriptyline causes the anticholinergic effect of urinary retention.

***A nurse is caring for a client who is taking acetazolamide for chronic open angle glaucoma. Which of the following adverse effects should the nurse instruct the client to monitor for and report to the primary care provider? -Tingling of fingers -Constipaiton -Weight gain -Oliguria

Correct: Tingling of fingers Rationale: The nurse should instruct the client to report the adverse effect of paresthesia, a tingling sensation in the extremities, when taking acetazolamide.

17. Administer epinephrine 0.5 mL via IV bolus. Discontinue the medication IV infusion. Elevate the client's legs above the level of the heart. Collect a blood specimen for ABGs

Correct: Rationale:

Teaching a pt who is to have a colonoscopy and Rx for polyethylene glycol-electrolyte solution and bisacodyl. Which of the following statements should the nurse make? "Expect a bowel movement 2 hr following the first dose of the bowel cleanser." "Plan to drink 2 liters of the bowel cleanser solution." "Plan to drink 1 large glass of red cranberry juice the day before the procedure." "Expect to drink the bowel cleanser solution over an 8 hr period."

Correct: Rationale:

RN is providing teaching to a pt with multiple sclerosis and a new Rx for methylprednisolone. Which of the following instructions should the RN include? SATA -Blood glucose levels will be monitored during therapy. -Avoid contact with people who have known infections. -Take the medication 1 hr before breakfast. -Decrease dietary intake of foods containing potassium. -Grapefruit juice can increase the effects of the medication.

Correct: -Blood glucose levels will be monitored during therapy. -Avoid contact with people who have known infections. -Grapefruit juice can increase the effects of the medication. Rationale: The nurse should monitor the client for hyperglycemia while providing methylprednisolone to the client. Glucocorticoids, such as methylprednisolone, increase serum glucose levels and can require management with insulin or antihyperglycemics. The nurse should instruct the client to avoid exposure to infectious agents, such as contact with those who have active infections or illnesses. Glucocorticoids, such as methylprednisolone, depress the immune system, placing the client at an increased risk for developing an infection. The nurse should instruct the client that grapefruit and grapefruit juice can increase the level of methylprednisolone in the body.

A nurse is teaching a client about warfarin. The client asks if they can take aspirin while taking the warfarin. Which of the following responses should the nurse make? "It is safe to take an enteric-coated aspirin." "The INR lab work must be monitored more frequently if aspirin is taken." "Acetaminophen may be substituted for aspirin." "Aspirin will increase the risk of bleeding."

Correct: "Aspirin will increase the risk of bleeding." Rationale: Aspirin inhibits platelet aggregation and can potentiate the action of the anticoagulant warfarin. Therefore, the client should avoid taking aspirin because it increases the risk for bleeding.

A nurse is caring for a patient who is refusing to take their schedules morning furosemide. Which of the following statements should the nurse make? -"If you do not take your furosemide, we might get in trouble." -"You can double your dose of furosemide this evening if that would be better for you." -"By not taking your furosemide, you might retain fluid and develop swelling." -"I'll go ahead and mix the furosemide into your breakfast cereal."

Correct: "By not taking your furosemide, you might retain fluid and develop swelling." Rationale: The nurse should respect the client's right to refuse the medication and inform the client of the risks of not taking the medication, notify the provider, and document the refusal. Furosemide is a loop diuretic given to reduce edema.

RN is planning DC teaching for a pt with an Rx for furosemide. What statement should RN include in pt teaching? "This medication increases your risk for hypertension." "Avoid potassium-rich foods in your diet." "Take each dose of medication in the evening before bed." "Drink a glass of milk with each dose of medication."

Correct: "Drink a glass of milk with each dose of medication." Rationale: The client should take furosemide with food or milk to reduce gastric irritation. The client who takes furosemide has an increased risk for potassium loss because of the diuretic effect of the medication that causes excretion of potassium through the kidneys. The client should increase their intake of potassium-rich foods. The client should take each dose of medication in the morning to avoid sleep disturbances from nocturia. The client who takes furosemide has an increased risk of hypotension due to fluid loss from the diuretic effect of the medication.

***A nurse is teaching a client who is to start taking famotidine for peptic ulcer disease. Which of the following client statements should the nurse identify as understanding of the teaching? "I will stop taking famotidine when my stomach pain is gone." "I will take famotidine anytime my stomach hurts." "I know smoking makes famotidine less effective." "I know that famotidine will turn my stools black."

Correct: "I know smoking makes famotidine less effective." Rationale: The nurse should instruct the client that smoking decreases the effectiveness of famotidine by exacerbating the ulcer manifestations.

23. Update the client's medical record. Notify the provider. Withhold the medication. Inform the pharmacist of the client's allergy to penicillin.

Correct: Withhold the med Rationale: When using the urgent vs nonurgent approach to client care, the nurse should determine that the priority action is to withhold the medication to prevent injury to the client.

19. A nurse is caring for a client who received 0.9% sodium chloride 1L over 4 hr instead of over 8 hr as prescribed. Which of the following information should the RN enter as documentation of the incident? -IV fluid infused over 4 hr instead of the prescribed 8 hr. Client tolerated fluids well, provider notified. -1 L of 0.9% sodium chloride completed at 0900. Client denies shortness of breath. -0.9% sodium chloride 1 L IV infused over 4 hr. Vital signs stable, provider notified. -IV fluid initiated at 0500. Lungs clear to auscultation.

Correct: 0.9% sodium chloride 1 L IV infused over 4 hr. Vital signs stable, provider notified. Rationale: The nurse should document the type and amount of fluid, how long it took to infuse, provider notification, and the client's physical status.

21. ***RN caring for parent of a NB. Parent asks when their NB should receive their first DTaP shot. What age should RN advise parent to immunize NB? At birth 6 months 2 months 15 months

Correct: 2 monthts Rationale: The CDC recommends that newborns receive the first dose of the five-dose series of the DTaP immunization at 2 months of age. According to the current recommended immunization schedule, only the hepatitis B vaccine is given at birth.

30. Tc for pt with acute acetaminophen toxicity. RN should admin? Vitamin K Physostigmine Benztropine Acetylcysteine

Correct: Acetylcysteine Rationale: Acetylcysteine is a specific antidote for acetaminophen toxicity. It can prevent severe injury when given orally or by IV infusion within 8 to 10 hr.

***A nurses is reviewing the medical record of a client who has hypertension. The nurse should idenityf which of the following findings as a contraindication for receiving propoanolol? -Cholelithiasis -Asthma -Angina pectoris -Tachycardia

Correct: Asthma Rationale: Asthma is a contraindication for receiving propranolol. Propranolol is an adrenergic antagonist that blocks the beta2 receptors in the lungs, causing bronchoconstriction and leading to serious airway resistance and possibly respiratory arrest.

A nurse is administering baclofen to a client who has a spinal cord injury. Which of the following findings should the nurse document as a therapeutic outcome? -Increase in seizure threshold -Decrease in flexor and extensor spasticity -Increase in cognitive function -Decrease in paralysis of the extremities

Correct: Decrease in flexor and extensor spasticity Rationale: A client who has a spinal cord injury and takes baclofen (a skeletal muscle relaxant) can experience a decrease in the frequency and severity of muscle spasms and in flexor and extensor spasticity.

22. ***RN is admin donepezil to a pt with Alzheimers disease. Which of the following should RN report to HCP immediately? Dyspepsia Diarrhea Dizziness Dyspnea

Correct: Dyspnea Rationale: When using the airway, breathing, circulation approach to client care, the nurse should report the adverse effect of dyspnea, caused by bronchoconstriction, to the provider first. Bronchoconstriction, dyspepsia, diarrhea, and dizziness are caused by the increase in acetylcholine levels, which is a primary effect of donepezil.

A nurse is reviewing the electronic medical record for a client who is receiving heparin via continuous IV infusion for deep vein thrombosis. Which of the following findings should the nurse identify as an adverse effect of heparin that requires notification of the provider? -Urinary frequency -Xerostomia -Diplopia -Generalized petechiae

Correct: Generalized weakness Rationale: The nurse should identify that generalized petechiae is an indication of thrombocytopenia, which is a potential adverse effect of heparin. The client is at an increased risk for hemorrhage, which can be fatal. Therefore, the nurse should notify the provider of this finding.

29. *** Tachycardia Oliguria Xerostomia Miosis

Correct: Miosis Rationale: Miosis, which is pupillary constriction, is a common adverse effect of neostigmine due to the excessive muscarinic stimulation that causes difficulty with visual accommodation.

28. Tx for heroin toxicity in pt who is unresponsive with pinpoint pupils and a RR of 6/min. RN should admin? Methadone Bupropion Diazepam Naloxone

Correct: Naloxone Rationale: The nurse should administer naloxone, an opioid antagonist, to a client who has heroin toxicity to reverse the respiratory depressive effects of the heroin. However, the nurse should not administer naloxone too quickly because naloxone can cause hypertension, tachycardia, nausea, vomiting, and might cause the client to enter a state of opioid withdrawal.

20. RN providing teaching to a pt with an Rx for feurrous sulfate. The RN should instruct the pt to take the med with what to promote absorption? Vitamin E Orange juice Milk Antacids

Correct: Orange Juice Rationale: The absorption of ferrous sulfate is enhanced by a vitamin C source, such as orange juice.

A nurse at a clinic is providing follow up care for a client who is taking fluoxetine for depression. Which of the following findings should the nurse identify as an adverse effect of the medication? Tingling toes Absence of dreams Sexual dysfunction Pica

Correct: Sexual dysfunction Rationale: Sexual dysfunction (a decreased libido), impotence, and delayed orgasm, or anorgasmia, is a common adverse effect of fluoxetine and occurs in about 70% of clients who take this SSRI antidepressant.

A nurse is administering digoxin immune fab to a client following a medication error. Which of the following findings should the nurse identify as an indication that the medication was effective? -Sinus rhythm -A decrease in the platelet count -An increase in the alanine transaminase (ALT) level -Deep tendon reflexes 2+

Correct: Sinus rhythm Rationale: Digoxin immune Fab is the antidote for digoxin toxicity. Dysrhythmias are a life-threatening adverse effect of digoxin toxicity. Therefore, the return of the client's heart to a sinus rhythm indicates a therapeutic response to the antidote, digoxin immune Fab. Digoxin is a cardiac glycoside and anti-arhythmic.

Rn admins ceftazidime to a pt who has severe penicillin allergy. The RN should identify that which of the following pt findings indicates RN should make an incident report? The client reports shortness of breath. The client is also taking lisinopril. The client's pulse rate is 60/min. The client's WBC count is 14,000/mm3 (5,000 to 10,000/mm3).

Correct: The client reports shortness of breath. Rationale: A severe penicillin allergy is a contraindication for taking ceftazidime, a cephalosporin antibiotic, due to the potential for cross-sensitivity. Shortness of breath can indicate the client is developing anaphylaxis.

A nurse is providing teaching to a client who is taking sumatripan. Which of the following adverse effects should the nurse instruct the client to monitor for and report to the provider? Chest pressure White patches on the tongue Bruising ​Insomnia

Correct: chest pressure Rationale: Sumatriptan is an antimigraine agent that can cause coronary vasospasms, resulting in angina. The client should report chest pressure or heavy arms to the provider.

26. Ondansetron Magnesium sulfate Flumazenil Protamine sulfate

Correct: flumazenil Rationale: The nurse should anticipate administering flumazenil, an antidote used to reverse benzodiazepines such as diazepam.

24. *** Bradycardia Hyperkalemia Loss of smell Hypoglycemia

Correct: hyperkalemia Rationale: Enalapril improves cardiac functioning in clients who have heart failure and can cause hyperkalemia due to potassium retention by the kidneys. Enalapril is an ACE inhibitor that has several cardiovascular adverse effects including hypotension, tachycardia, and dysrhythmias. Enalapril can cause several sensory adverse effects, such as a loss of taste. However, it does not cause a loss of smell.

25. Hot flashes Gastrointestinal irritation Vaginal dryness Leg tenderness

Correct: leg tenderness Rationale: The greatest risk to this client is the development of a thromboembolism, which is an adverse effect of tamoxifen. The nurse should also monitor the client for other manifestations of a thromboembolism, including leg tenderness, redness, swelling, and shortness of breath.

***A nurse is caring for a client in a clinic. Nurses' Notes 3 months ago: Client was educated on non-pharmacological interventions to lower blood pressure such as exercise and a low-fat, low-sodium diet with fresh fruits and vegetables. Client to return to office for a follow-up visit in 3 months. Today: Blood pressure is still elevated. Provider notified and prescription given to the client. The client was educated on the medication. Captopril 12.5 mg twice a day by mouth. Which client statements indicate an understanding of the teaching? Click to specify if the client statement indicates an understanding or need for further education. -"Coughing is expected while taking this medication." -"I will eat foods high in potassium." -"I will notify my provider if I feel sick." -"I should take this medication with meals." -"I should take acetaminophen instead of ibuprofen for a headache."

Understanding: -"I will notify my provider if I feel sick" -"I should take acetaminophen instead of ibuprofen for a headache" Rationale: Captopril can cause neutropenia. If a client develops manifestations of infection such as a fever or sore throat, the provider should be notified. NSAIDS such as ibuprofen may reduce the effectiveness of captopril and should be avoided. Need for further education: -"I will eat foods high in potassium" -"Coughing is expected while taking this medication" -"I should take this medication with meals Rationale: Hyperkalemia is an adverse effect of captopril. The client should avoid potassium supplements and potassium-sparing supplements. Coughing is an adverse effect of captopril (ACE cough) and the nurse should notify the provider. Captopril should be given one hour before meals or two hours after meals.